Complicaciones postoperatorias tardías en pacientes quirúrgicos: revisión integradora

Sousa, Álvaro Francisco Lopes de; Bim, Lucas Lazarini; Hermann, Paula Regina de Souza; Fronteira, Inês; Andrade, Denise de

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REVIEW • Rev. Bras. Enferm. 73 (5) • 2020 • https://doi.org/10.1590/0034-7167-2019-0290 copiar

Complicaciones postoperatorias tardías en pacientes quirúrgicos: revisión integradora

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

identificar las principales complicaciones que ocurren en el postoperatorio tardío de los pacientes quirúrgicos.

Método:

revisión integradora de CINAHL, LILACS, Science Direct, Web of Science, SCOPUS, Europe PMC y MEDLINE. Descriptores y palabras clave fueron combinadas sin restricción de idioma o tiempo.

Resultados:

se incluyeron diez estudios primarios. Las complicaciones infecciosas fueron las más comunes, especialmente la infección del sitio quirúrgico, la neumonía y la infección del tracto urinario. La presencia de complicaciones se relacionó con un aumento de la mortalidad, la necesidad de reoperaciones y una peor supervivencia. Pocos estudios informan sobre la frecuencia de monitoreo, el tiempo de seguimiento y/o cuándo comenzaron a observarse complicaciones.

Conclusión:

las complicaciones infecciosas fueron las más frecuentes después de la operación. La escasez de pautas que guían la vigilancia de las complicaciones con respecto a la frecuencia de monitoreo, el tiempo de seguimiento y la clasificación hace que sea difícil establecer una visión general de las mismas y, en consecuencia, proponer estrategias de intervención,

Descriptores:
Procedimientos Quirúrgicos Quirúrgicos; Complicaciones; Complicaciones Postoperatorias; Monitoreo Epidemiológica; Infecciones

Reason for exclusion	Quantitative excluded (n= 1847)
Duplicate studies	372
Does not address surgical patient	379
Performed exclusively with a patient aged 18 or younger.	15
Performed exclusively with a patient over 80 years old	08
Addresses pre and/or intraoperative patient complications	423
Addresses patient complications only in the immediate postoperative period	371
Does not address complications	175
Review studies	47
Opinion studies	53
Protocols	04

Article title	Year/Country	Outlining/Participants	Outcomes/Conclusions
The AFC Score: Validation of a 4-Item Predicting Score of Postoperative Mortality After Colorectal Resection for Cancer or Diverticulitis: Results of a Prospective Multicenter Study in 1049 Patient^s(¹⁹19 Alves A, Panis Y, Mantion G, Slim K, Kwiatkowski F, Vicaut E. The AFC Score: Validation of a 4-Item Predicting Score of Postoperative Mortality After Colorectal Resection for Cancer or Diverticulitis: Results of a Prospective Multicenter Study in 1049 Patients. Ann Surg [Internet]. 2007;246(1):91-6. doi: 10.1097/SLA. 0b013e3180602ff5 https://doi.org/10.1097/SLA. 0b013e31806... )	2007 France	A multicenter study to assess mortality and morbidity after colorectal surgery. N= 1,049 patients	The main complications were: dehiscence and wound infection (8%), postoperative hemorrhage (3%), and complications related to the cardiorespiratory tract (7%). Postoperative morbidity was observed in a significant portion (23%) of patients. Post-discharge reoperation due to complications was required in 42 patients (4%).
Complications after pancreaticoduodenectomy are associated with higher amounts of intra- and postoperative fluid therapy: A single center retrospective cohort stud^y(²⁰20 Kulemann B, Fritz M, Glatz T, Marjanovic G, Sick O, Hopt UT, et al. Complications after pancreaticoduodenectomy are associated with higher amounts of intra-and postoperative fluid therapy: a single center retrospective cohort study. Ann Med Surg. 2017;16:23-9. doi: 10.1016/j.amsu.2017.02.042 https://doi.org/10.1016/j.amsu.2017.02.0... ⁾	2017 Germany	A descriptive, documentary and retrospective study with patients submitted to duodenopancreatectomy. N: 553 patients	Infection, fistula, delayed gastric emptying and bleeding were the main complications. The incidence of complications was high (44.7%), with morbidity of 59.5%. Long-term mortality (30 days post-discharge) was 1.1%. Postoperative intervention was required to treat complications in 28.3% of patients, of which 12.1% reoperations.
Systematic Classification of Morbidity and Mortality After Thoracic Surgery⁽²¹21 Seely AJ, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. 2010;90(3):936-42. doi: 10.1016/j.athoracsur.2010.05.014 https://doi.org/10.1016/j.athoracsur.201... ⁾	2010 Canada	A retrospective study assessing postoperative complications in thoracic surgery. N: 953 patients	Complication rates were 29.3%. The main ones were Surgical Wound Infection (30.8%), prolonged air escape (18.8%), atrial fibrillation (18.2%), and pneumonia (9.7%).
Morbidity after Total Gastrectomy: Analysis of 238 Patients⁽²²22 Selby LV, Vertosick EA, Sjoberg DD, Schattner MA, Janjigian YY, Brennan MF. Morbidity after total gastrectomy: analysis of 238 patients. J Am Coll Surg. 2015;220(5):863-71.e2. doi: 10.1016/j.jamcollsurg.2015.01.058 https://doi.org/10.1016/j.jamcollsurg.20... ⁾	2015 United States	A 90-day prospective follow-up cohort N: 238 students	The incidence of complications was 30%. The main ones were surgical wound infection (18.5%), esophageal anastomotic leak (14.7%), respiratory system complications (14.3%), cardiac arrhythmia (9.7%), organ-cavity infection (4.2%), and hemorrhage (3.4%). The readmission rate was high (20%). The presence of one or more complications increased the hospitalization time of the subjects.
Post-Discharge Complications are an Important Predictor of Post-operative Readmissions⁽²³23 Tevis SE, Kohlnhofer BM, Weber SM, Kennedy GD. Post-discharge complications are an important predictor of postoperative readmissions. Am J Surg. 2014;208(4):505-10. doi: 10.1016/j.amjsurg.2014.05.013 https://doi.org/10.1016/j.amjsurg.2014.0... ⁾	2014 United States	A retrospective study with patient undergoing general surgery. N: 3,556 patients	The incidence of complications was 31%, the most common being gastrointestinal complications (29.5%), surgical site infection (organ-cavity, superficial, deep and dehiscence) (26.3%), sepsis (3.8%), and urinary tract infection (2.9%). The average time between discharge and post-discharge complication was 10 days.
Value of General Surgical Risk Models for Predicting Postoperative Liver Failure and Mortality Following Liver Surgery⁽²⁴24 Haga Y, Ikejiri K, Takeuchi H, Ikenaga M, Wada Y. Value of general surgical risk models for predicting postoperative liver failure and mortality following liver surgery. J Surg Oncol. 2012;106(7):898-904. doi: 10.1002/jso.23160 https://doi.org/10.1002/jso.23160... ⁾	2012 Japan	A prospective follow-up study of postoperative course of hepatectomy. N: 960 patients	The incidence of post-discharge complications was 16.6%, the most common being: wound infection (2.5%), pleural effusion (2.9%), abscess (2.5%), pneumonia (1.2%), and hemorrhage (0.7%).
The Percutaneous Nephrolithotomy Global Study: Classification of Complications⁽²⁵25 Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, et al. The percutaneous nephrolithotomy global study: classification of complications. J Endourol. 2011;25(8):1275-80. doi: 10.1089/end.2011.0067 https://doi.org/10.1089/end.2011.0067... ⁾	2011 PubMed	A multicenter study with patients undergoing percutaneous nephrolithotomy. N: 5,724 patients	The incidence of complications was 20.5%. The main ones were fever (13.7%), hemorrhage (12.5%), urinary leakage (3.4%), and infections (4.6%).
The Impact of Postoperative Complications on Survivals After Esophagectomy for Esophageal Cancer⁽²⁶26 Booka E, Takeuchi H, Nishi T, Matsuda S, Kaburagi T, Fukuda K. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine. 2015;94(33):e1369. doi: 10.1097/MD. 0000000000001369 https://doi.org/10.1097/MD. 000000000000... ⁾	2015 Japan	A retrospective cohort with surgical esophagectomy graduates N: 402 patients	There was a high incidence of surgical complications (40.1%), the main ones being pneumonia (22.5%), surgical wound infection (11.3%), anastomosis (15.8%), and laryngeal nerve paralysis (19.4%).
Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study⁽²⁷27 Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ Open. 2005;331:1374. doi: 10.1136/bmj.38643.663843.55 https://doi.org/10.1136/bmj.38643.663843... ⁾	2005 England	A prospective observational cohort of older adults undergoing hip fracture surgery. N: 2,448 patients	498 patients had at least one postoperative complication (20%). The most common were chest infection (9%), heart failure (5%) and other infections (organ-cavity, UTI) (5%). Mortality was 9.6% at 30 days after hospitalization. In patients who developed postoperative chest infection, mortality at 30 days was 43%.
Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Center⁽²⁸28 Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and lengthof stay in a tertiary care center. J Gen Intern Med. 2006;21(2):177-80. doi: 10.1111/j.1525-1497.2006.00319.x https://doi.org/10.1111/j.1525-1497.2006... ⁾	2005 Canada	A retrospective descriptive study in patients undergoing noncardiac surgery. N: 7,457 patients	About 6.9% of patients had at least one post-discharge complication. Pneumonia (3%), hemorrhage (1.8%), sepsis (1.3%), and cardiac complications (1.3%) were prevalent.

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[1] Corresponding author: Álvaro Francisco Lopes de Sousa. E-mail: alvarosousa@usp.br